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Case Report

An innovative cosmetic technique

called lip repositioning
Krishna Kumar Gupta, Amitabh Srivastava, Rameshwari Singhal, Sumedha
Srivastava

Department of Abstract:
Periodontology and A clinical report describing the successful use of the lip repositioning technique for the reduction of excessive
Implantology, Sardar gingival display. A female patient aged 34 years reported with a chief complaint of gummy smile and was treated
Patel Post Graduate with this technique performed under local anesthesia with the main objective to reduce gummy smile by limiting
Institute of Dental and the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli, orbicularis oris, and levator labii
Medical Sciences, superioris). The technique is fulfilled by removing a strip of mucosa from maxillary buccal vestibule and creating
a partial thickness flap between mucogingival junction and upperlip musculature, and suturing the lip mucosa with
Lucknow, Uttar Pradesh,
mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display.
India
Key words:
Gummy smile, lip repositioning, orthognathic surgery

INTRODUCTION CASE REPORT

S everal people have an illusion that they

possess gummy smile or that when they
smile most of the gums are visible since they
A female patient aged 34 years reported to the
department of Periodontology and Implantology,
Sardar Patel Post Gradute Institute of Dental
Access this article online have short teeth or gums have grown over their and Medical Sciences, Lucknow (India), with
Website: teeth. This makes them feel conscious and they the chief complaint of excessive display of gums
www.jisponline.com are unable to give a complete smile. However, while smiling. There was no significant medical
DOI: they should be aware that something can be or family history and patient was medically
10.4103/0972-124X.76936 done dentally to give them a beautiful smile. sound and fit for the surgical procedure. On
Quick Response Code: Gummy smile due to excessive gingival display clinical examination, extraorally face was found
always makes a normal person conscious while to be bilaterally symmetrical with incompetent
smiling, especially when the problem is related lips. Intraorally, a moderate gingival display
with female patients who are more esthetically was seen during smiling, which extended from
conscious than male. Gummy smile is seen due maxillary right first molar to maxillary left first
to improper relation between gingival tissue and molar [Figure 1].
the tooth, with gingival tissue in excess and tooth
portion in a small amount. Technique
Aim of the technique
Gummy smile is governed by various etiological Lip repositioning is a surgical way to correct
factors, for example jaw deformities, which gummy smile by limiting the retraction of the
cause excessive gingival display and require elevator smile muscles (e.g., zygomaticus minor,
a orthognathic surgery.[1] This occurs due to levator anguli, orbicularis oris, and levator labii
excessive increased vertical height of maxillary superioris).
arch. The orthognathic surgery is a complicated
procedure and requires team work with Surgical technique
Address for hospitalization and general anesthesia, while Complete extra oral and intraoral mouth
correspondence: lip repositioning is innovative and effective, less disinfection was done with 2% betadine,
Dr. Krishna Kumar Gupta, time consuming and is performed under local followed by infiltration with local anesthesia,
Vijay Nagar, anesthesia. (2% lignocaine hydrochoride with 1:80,000
Extension –III-A, epinephrine). Thereafter, the surgical area to
Kanpur Road, Lucknow, Apart from it, delayed eruption as a cause of excessive be operated was demarcated with the help of
Uttar Pradesh, India
gingival display and its treatment by esthetic crown an indelible pencil also shown in schematic
E-mail: drkkgupta26@
rediffmail.com
lengthening are well documented.[2,3] The clinician diagram [Figures 2 and 3]. The surgical area
must consider the dynamic relationship between started at the mucogingival junction, which
Submission: 27-11-2009 the patient’s dentition, gingival, and lips while extended 10−12 mm superiorly in the vestibule
Accepted: 21-08-2010 smiling.[4] [Figure 4]. Incisions were made in the above-

266 Journal of Indian Society of Periodontology - Vol 14, Issue 4, Oct-Dec 2010
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Gupta, et al.: An innovative cosmetic technique called lip repositioning

mentioned surgical area and both superior and inferior partial the underlying connective tissue exposed [Figures 6 and 7].
thickness flap was raised from maxillary right first molar to The parallel incision lines were approximated with interrupted
maxillary left first molar. The incisions were then connected stabilization sutures at the midline [Figures 8 and 9] and other
with each other in an elliptical outline. The epithelium was then location along the borders of the incision to ensure proper
removed [Figure 5] within the outline of the incision leaving alignment of the lip midline with the midline of the teeth and

Figure 1: Preoperative Figure 2: Area demarcated with indelible pencil

Figure 3: Demarcated area Figure 4: The surgical area started at the mucogingival junction, which extended
10-12 mm superiorly in the vestibule

Figure 5: Removing epithelium

Figure 6: Exposed connective tissue

Figure 7: Raw wound area Figure 8: Midline suture

Journal of Indian Society of Periodontology - Vol 14, Issue 4, Oct-Dec 2010 267
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Gupta, et al.: An innovative cosmetic technique called lip repositioning

then a continuous interlocking suture was used to approximate Precautions while surgery
both flaps. Sutures were resorbable in nature [Figures 10 and 1. Care must be taken to avoid damage to minor salivary
11]. Patient was discharged with all post surgical instructions glands in submucosa. Some cases with rare complication
and medications for five days which included analgesic reported in the literature are paresthesia[5] and transient
(ibuprofen 600 mg QID daily for 2 days), antibiotic (amoxicillin paralysis.[6]
500 mg TDS for five days), along with cold packs extra orally 2. Clinicians must look for adequate width of attached
to decrease post surgical swelling. gingiva.
3. Do not perform the procedure with patients having vertical
Patient was recalled after one week for a follow-up [Figure 12]. maxillary excess, in such cases orthognathic surgeries is the
The patient after a week complained of mild pain and tension solution
on the upper lip. It was seen later that the suture area healed
in the form of a scar [Figure 13 after 3 months], which was not DISCUSSION
apparent when the patient smiled because it was concealed in
the upper lip [Figure 14 after 6 months]. In most patients, the lower edge of the upperlip assumes a

Figure 9: Midline suture (schematic diagram of midline suture) Figure 10: Continuous interlocking sutures

Figure 11: Continuous suture Figure 12: After one week

Figure 13: After 3months Figure 14: Postoperative after 6 months

268 Journal of Indian Society of Periodontology - Vol 14, Issue 4, Oct-Dec 2010
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Gupta, et al.: An innovative cosmetic technique called lip repositioning

“gumwing” profile, which limits the amount of gingiva that is ACKNOWLEDGMENT

exposed when a person smiles. Patient who have a high lip line
exposes a broad zone of gingival tissue and may often express The author would like to thank Dr. O. P. Chaudhay, Chairman and
concern about their “gummy smile”. The form of the lips and Dr. Praveen Mehrotra, Principal of the college, for all his kind support
the position of the lips during speech and smiling cannot be required for the case report and preparation of the manuscript along
easily changed, but the dentist may, if necessary, modify/ with all the faculty members of the Department of Periodontology for
control the form of the teeth and interdental papillae as well their support and contributions.
as the position of the gingival margins and the incisal edges of
the teeth along with repositioning of the lip. In other words, REFERENCES
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Source of Support: Nil, Conflict of Interest: None declared.
results to the patient.

Journal of Indian Society of Periodontology - Vol 14, Issue 4, Oct-Dec 2010 269